Transient cerebrovascular accidents are a harbinger of cerebral strokes.
Strokes are as follows: Ischemic and hemorrhagic.
It is also called cerebral infarction, develops in violation (decrease) of cerebral blood flow . The most common cause of cerebral infarction is atherosclerosis, especially when it is combined with hypertension, diabetes mellitus, systemic diseases (collagenoses), syphilis, thrombangenitis obliterans , blood diseases, infectious diseases, intoxications, and injuries. And also with heart defects and myocardial infarction. Usually, ischemic stroke is preceded by a physical or mental strain. As a result of vascular occlusion (thrombosis, embolism, spasm) occurs cerebrovascular insufficiency , which leads to malnutrition of the brain tissue – heart attack. Sometimes this is preceded by headaches, a feeling of discomfort.
For ischemic stroke, a gradual increase in neurological symptoms from a few hours to 2-3 days is most characteristic . Their severity can “flicker”, then falling, then growing again. A characteristic of cerebral infarction is the prevalence of focal symptoms (numbness of the face, impaired speech, weakness in the limbs, impaired function), but there may be no headache, nausea, or vomiting. Blood pressure is either normal or low. As a rule, the temperature is not elevated, the face is pale, slightly cyanotic lips and a nasolabial triangle. The pulse is rapid, weak, low filling. Most often, such patients had heart pains that indicate angina pectoris , or such patients suffered a myocardial infarction, were observed by a cardiologist with symptoms of coronary cardiosclerosis and coronary heart disease. Heart rhythm disturbances are recorded. There is a decrease in pulsation of the great vessels.
Focal symptoms in ischemic stroke depend on the location of cerebral infarction.
- Of the focal symptoms in lesions of the cerebral hemispheres , paralysis or paresis is observed in the opposite limb lesion in combination with central paresis of the facial or sublingual nerve (on the affected side: face on the right – leg and arm on the left). With left hemisphere foci, a speech disorder is often observed, with right hemisphere foci – a violation of the body scheme, the patient does not recognize his own physical defect ( anosognosia ).
- If the ischemic lesion is localized in the area of the brain stem, then along with paresis of the extremities, nuclei of the cranial nerves are affected. Often oculomotor disorders, twitching of the eyeballs when looking to the side, dizziness, impaired statics and coordination, impaired speech with full understanding (the speech apparatus suffers), swallowing disorder and other vital functions. A headache in the cervical-occipital region may bother.
- In special cases, the cause of a stroke is an embolism of the cerebral vessels, i.e., a blockage of the vessel with an embolus . In this regard, much of what has been said above about the clinic of ischemic stroke also applies to cerebral embolism. However, there are some features of strokes due to embolism. The most common cardiogenic embolism in valvular heart disease, rheumatic endocarditis, bacterial endocarditis, during heart surgery, myocardial infarction, cardiosclerosis, sclerosis of the aorta and major vessels, as well as blood clots of all limbs. Sometimes embolism occurs with purulent processes in the lungs, infectious diseases, malignant tumors. Fat embolism may occur during fractures of the tubular bones, gas embolism during lung operations, during caisson work.
Neurological symptoms develop instantly, often there is a short-term loss of consciousness, and, in addition to the symptoms of prolapse (paralysis, paresis, speech impairment, etc.), symptoms of irritation in the form of epileptiform seizures, tension of the occipital muscles ( meningial symptoms), and visual impairment are observed during embolism . Blood pressure is normal or low. With fat embolism, the clinical picture of a stroke develops after a few hours or a day. And this is preceded by pulmonary disorders in the form of cough, shortness of breath, hemoptysis, as fatty particles pass through the lungs.